- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,162.28 / $9,332.54
| Facility | | $812.83 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $602.56 / $1,318.26
| Professional | | $478.63 | $602.56 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,570.88 / $10,232.93
| Facility | | $1,698.24 | $4,570.88 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $691.83 / $1,318.26
| Professional | | $457.09 | $691.83 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $1,584.89 / $4,570.88
| Facility | | $323.59 | $1,584.89 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $794.33 / $1,737.80
| Professional | | $512.86 | $794.33 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,862.09 / $4,677.35
| Facility | | $363.08 | $1,862.09 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $645.65 / $1,202.26
| Professional | | $446.68 | $645.65 | $1,202.26 |